Queen’s Speech

Lord Bishop of Chichester Excerpts

Thursday 3rd June 2010 Lords Chamber

[The Lord Bishop of Chichester]

My Lords, on behalf of these Benches, I echo the noble Baroness’s welcome of the noble Lord, Lord Hill, to the House. I congratulate him on becoming a Minister and thank him for a fine and engaging maiden speech. We look forward to hearing much from him.

It is a fine aspiration to strengthen the voice of patients and the role of doctors in the National Health Service. On reflection, it may actually be two aspirations. It seems that a certain caution may be required when one reads that the National Health Service is to be both “patient led” and “led by clinical decision makers”. It is important to ensure that these become, as a far as possible, a single aspiration rather than two competing aspirations.

The Government's background note suggests that the reference to doctors is shorthand for front-line medical staff more generally. It is good that the role of nurses is specifically mentioned. Less welcome, however, is the absence of a mention of other front-line health workers, whose increasing recognition as members of multidisciplinary teams has been a notable sign of the progress made over the past decade.

Human health and well-being, including better clinical outcomes, require a whole approach in which doctors, nurses, allied health professionals, psychologists, chaplains and social workers all play key roles. The 1996 Department of Health document, Standards for Better Health, requires healthcare organisations to co-operate with other agencies to ensure that patients' individual requirements are taken into account and that,

“their physical, cultural, spiritual and psychological needs and preferences”,

are met. So we await with interest discussion and clarification of what is meant by, and who is included in, “front-line workers”.

It may be worth pointing out that a chaplain often serves more patients directly each week than any other single healthcare professional working in a hospital. Although his or her role may not usually be immediately life-saving, neither is the everyday work of most doctors, nurses and allied health professionals. In any case, life-saving is not all that is meant by good-quality healthcare. I hope that Her Majesty’s Government will assure us that chaplains are valued within the National Health Service as front-line staff.

In his preface to National Standards, Local Action, published in 2004, the then chief executive of the National Health Service and Permanent Secretary of the Department of Health, the noble Lord, Lord Crisp—Sir Nigel Crisp as he then was—wrote of the importance of,

“giving the individual—the patient, service user or client—more power to improve their care and drive the whole system”.

He also quoted the striking expression the “expert patient” which had acquired considerable currency, and some criticism, since being coined I think by Sir Liam Donaldson some years previously.

Greater patient voice is obviously to be welcomed, provided it is recognised that it is not easy for all to have or find a voice—such as the unborn or those with severe learning difficulties, mental health problems or dementia. Just as strengthening the role of doctors must also mean strengthening the role of other front-line health workers, including chaplains, so too strengthening the voice of patients must imply allowing a wider advocacy on behalf of patients by family, friends and carers.

Of course, empowering patients and their advocates is meaningless unless they are enabled to make more informed judgments about their needs. I was very grateful for what the Minister said in answer to a question about dementia earlier. It is very important that the Government should explain carefully how genuine patient empowerment will be implemented. This must include not only giving people more say over their own treatment, but also recognising the contribution that those who are receiving or have received care through the National Health Service can make to the formulation of policy and the oversight of delivery at every level whether local or national.

It is also important to know how changing policies will impact on current inequalities in healthcare provision and outcomes, whether those inequalities are geographical or based on resources and wealth. Enthusiasm for local action must always be in the interests of the highest standards for all. At a time of financial stringency, it is also essential to ensure that those with the greatest need receive particular attention. Special care must be taken to avoid any suggestion that some people are less valuable than others or that the chronically or terminally ill, the disabled and the elderly are, or are ever allowed to feel that they are, a burden on the rest of us.

It is also important to avoid simplistic attacks on administrators, contrasting them unfavourably with front-line staff. Although the National Health Service, like many other institutions—dare I say the Church of England?—has often been over-administered, good management and administration are essential for any organisation. Serious consequences follow when those delivering services are undermined and undervalued. Pushing more and more management tasks on to front-line healthcare staff is dangerous. Not only are they not equipped for those tasks, but if much of their time and energy is spent on managing, that must detract from their ability to deliver front-line care. Managers are a very easy target, but a scattergun approach to management reform could lead to greater problems and greater inefficiencies within the National Health Service.

My final point concerns targets. Although some targets encourage a box-ticking culture and approach, others, if evidence-based and tested against outcomes, can undoubtedly contribute towards the health and well-being of the population—for example, those stipulating waiting times for appointments and treatment. Of course targets can be abused, but it is important not to throw the baby out with the bathwater.